Am Papri Das, M. Sc (N) Community Health Nursing faculty with more than 23 yrs of experience working as Vice-Principal at Peerless College of Nursing. Power point presentation on topic "Community Based Rehabilitation" It will be of great help to Nursing student in graduate and post graduate level. as possible in the interest of the students. Hope the topic will be beneficial to the students folk.

1. COMMUNITY BASED
REHABILITATION
Presented By-
Ms. Papri Das
Assistant Professor
Peerless College of Nursing

2. The emergence of the concept ofThe emergence of the concept of
Community Based RehabilitationCommunity Based Rehabilitation
“If you give a person a
fish,
he’ll eat for a day;
if you teach him to fish,
he’ll eat for a lifetime.”

3. The emergence of the concept ofThe emergence of the concept of
Community Based RehabilitationCommunity Based Rehabilitation
“If you give a person a
fish,
he’ll eat for a day;
if you teach him to
fish,
he’ll eat for a lifetime.”

4. Community Based Rehabilitation
(CBR)
brings rehabilitation know-how to
villages
and urban slums, and CBR personnel
facilitate people to take
responsibility for their own lives!

5. WHATWHAT IS CBR?IS CBR?
CBRCBR isis aa systematizedsystematized approachapproach
withinwithin general community developmentgeneral community development
wherebywhereby Persons with DisabilitiesPersons with Disabilities areare
enabledenabled
toto livelive aa fulfilling lifefulfilling life
within theirwithin their own communityown community,,

6. making maximum use ofmaking maximum use of local resourceslocal resources
and helping theand helping the community becomecommunity become awareaware
of it’s responsibility in ensuring theof it’s responsibility in ensuring the
inclusion andinclusion and equalequal participation of PWDs.participation of PWDs.
In the process,In the process, PWDsPWDs areare also madealso made awareaware
of their own role and responsibility, as theyof their own role and responsibility, as they
are part of the community.are part of the community.

7. Definition of CBRDefinition of CBR
““a strategy within general communitya strategy within general community
development for thedevelopment for the rehabilitation,rehabilitation,
equalization of opportunities and socialequalization of opportunities and social
inclusion ofinclusion of all people withall people with
disabilities.disabilities.””

8. CBR isCBR is implementedimplemented through the combinedthrough the combined
efforts of PWDs themselves, their families,efforts of PWDs themselves, their families,
organizations and communities, and theorganizations and communities, and the
relevant governmental and non-governmentalrelevant governmental and non-governmental
health, education, vocational, social andhealth, education, vocational, social and
other services.other services.

9. Side stream
Your Boat
Mainstream
What if you are in the Mainstream?
What if you are in the Side stream?

10. Mainstreaming and inclusionMainstreaming and inclusion
 Mainstreaming and inclusion is seen as anMainstreaming and inclusion is seen as an
effective way:effective way:
(a) to include persons with disability(a) to include persons with disability
(b) to give equal opportunities and(b) to give equal opportunities and
(c) to provide a non-discriminative(c) to provide a non-discriminative
environment for their growth andenvironment for their growth and
development.development.

11. Major ObjectivesMajor Objectives
To ensure that PWDs are able to maximize their physicalTo ensure that PWDs are able to maximize their physical
and mental abilities,and mental abilities,
to access regular services and opportunities, and toto access regular services and opportunities, and to
become active contributors to the community andbecome active contributors to the community and
society at large.society at large.
To activate communities to promote and protect theTo activate communities to promote and protect the
human rights of PWDs through changes within thehuman rights of PWDs through changes within the
community, for example, by removing barriers tocommunity, for example, by removing barriers to
participation.participation.

12. Evolution ofEvolution of
Concepts in CBRConcepts in CBR
 Disability and RehabilitationDisability and Rehabilitation
 Disability is no longer viewed as
merely the result of impairment.
 The social model of disability has
increased the awareness that
environmental barriers
(attitudinal, physical and institutional)
to participation impede the functioning
of PWDs as equals.

13. Evolution ofEvolution of
Concepts in CBRConcepts in CBR
 Disability and RehabilitationDisability and Rehabilitation
 Professionals (medical and other) who
provide rehabilitation services have the
responsibility to provide relevant
information to PWDs / their families so that
they can make informed decisions to
enable them to lead a fulfilling life.

14. Evolution ofEvolution of
Concepts in CBRConcepts in CBR
 Human RightsHuman Rights
 CBR promotes the rights of PWDs to live
as equal citizens within the community,
to enjoy health and well being, to
participate fully in educational, social,
cultural, religious, economic and political
activities.

15. Evolution ofEvolution of
Concepts in CBRConcepts in CBR
 PovertyPoverty
 There is a strong correlation
between disability and poverty.
 Poverty leads to increased disability, and
disability in turn leads to increased
poverty.

16. Evolution ofEvolution of
Concepts in CBRConcepts in CBR
 PovertyPoverty
 In 2000, the UN Member States adopted
the Millennium Declaration and set eight
Millennium Development Goals
(MDGs) to guide the implementation of
the Declaration.
All the goals are relevant to disability and
three goals are of particular concern to
PWDs and their families:

17. Eradicate severe poverty and hunger.
Promote gender equality and
empower women.
None of these goals can be
effectively achieved
without the inclusion of PWDs
Reduce mortality and Morbidity

18. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
The principles are
overlapping,
complimentary and
inter-dependent – they
cannot be separated
one from the other.
Source: World Health Organization: Meeting Report on the development of guidelines for
Community Based Rehabilitation (CBR) programmes : (1 st and 2 nd November 2004, Geneva,
Switzerland)
HOW

19. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 InclusionInclusion
 Inclusion means the removal of all kinds
of barriers which block PWDs from
access to the mainstream.
 Inclusion means placing disability issues
and PWDs in the mainstream of activities,
rather than as an after-thought.
 Inclusion means including all forms
of impairment.

20. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 InclusionInclusion
 Inclusion also means ‘convergence’ –
that is, the involvement of PWDs in the
campaigns, struggles and activities of
other oppressed groups which are not
centred exclusively on disability issues,
such as children living on the streets,
farmers, land rights and environment,
women’s groups.

21. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 ParticipationParticipation
 Participation means the involvement of
PWDs as active contributors to the CBR
programme from policy making to
implementation and evaluation, for the
simple reason that they know best what
they need.

22. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 ParticipationParticipation
 Participation also means PWDs being a
critical resource within any CBR
programme – providing training, making
decisions etc.
 It covers the participation of women in all
processes and decision-making, and that
of other groups who are typically not
listened to or excluded.

23. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 SustainabilitySustainability
 The benefits of the programme must be
lasting.
 The activity initiated through the CBR
programme must be sustainable beyond
the immediate life of the programme itself
– able to continue beyond the initial
intervention and thrive independently
of the initiating agency.

24. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 SustainabilitySustainability
 Strong links between GOs, NGOs, CBOs
and DPOs will contribute towards
sustainability.
 This means that DPOs and SHGs are
the hub of any CBR activity.

25. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 EmpowermentEmpowerment
 Empowerment means that local people,
and specifically PWDs and their families,
make the programme decisions and
control the resources.
 It means PWDs taking leadership
roles within programmes.

26. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 EmpowermentEmpowerment
 The empowerment of women is central to
any programme.
 Empowerment necessitates capacity
building – that is, the developing and using
of the skills necessary to act with authority
and responsibility, independent of the
initiating agencies and CBR
programme managers.

27. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 AdvocacyAdvocacy
 Advocacy means the central and
consistent involvement of PWDs and their
families defining for themselves the goals
and processes for poverty alleviation.

28. BASIC PRINCIPLES OFBASIC PRINCIPLES OF
A CBR PROGRAMMEA CBR PROGRAMME
 AdvocacyAdvocacy
 Advocacy is a collective notion not an
individualistic one. It means self-
determination.
 It means mobilizing, organizing,
representing, creating space for
interaction and demands.

30. ESSENTIAL COMPONENTS OFESSENTIAL COMPONENTS OF
A CBR PROGRAMMEA CBR PROGRAMME
1. Cover all types of PWDs who need rehabilitation
services.
2. Part of mainstream development and have a
multi-sectoral approach : including social
integration interventions, health, education and
economic programmes.
3. The programme should have access to or
generate a good and effective referral system.

31. 4.4. The programme should aim atThe programme should aim at fullfull
integration of the PWDintegration of the PWD into his / herinto his / her
community.community.
5.5. The programme should haveThe programme should have gender andgender and
disability focus and balancedisability focus and balance..
6.6. The programme needs to haveThe programme needs to have
committed and well trained communitycommitted and well trained community
members as service providersmembers as service providers..

32. 5.5. The programme shouldThe programme should strike a balancestrike a balance
between provision of service delivery andbetween provision of service delivery and
empowering the PWD, family and communityempowering the PWD, family and community
through regular transfer of skills.through regular transfer of skills.
6.6. The programme shouldThe programme should facilitate the formationfacilitate the formation
and strengthening of the disabled people’sand strengthening of the disabled people’s
movement to ensure that the rights of themovement to ensure that the rights of the
PWDs are not deniedPWDs are not denied through advocacy atthrough advocacy at
local, state and national level.local, state and national level.

33. COMMUNITY BASED
REHABILITATION
PRINCIPLES: PARTICIPATION ~ INCLUSION ~ SUSTAINIBILITY ~ SELF ADVOCACY
HEALTH
PROMOTIVE
PREVENTIVE
CURATIVE
REHABILITATIVE
EDUCATION
EARLY
CHILDHOOD
DEVELOPMENT
NON-FORMAL
FORMAL
SCHOOL
HIGHER
LIVELIHOODS
SKILLS
DEVELOPMENT
INCOME
GENERATING
ACTIVITIES
ACCESS TO
FINANCIAL
SERVICES
OPEN
EMPLOYMENT
EMPOWERMENT
SELF-HELP
GROUPS
DISABLED
PEOPLE'S
ORGANIZATION
SOCIAL
MOBILISATION
POLITICAL
EMPOWERMENT
SOCIAL
LEGAL
PROTECTION
CULTURE &
RELIGION
SPORTS &
LEISURE
RELATIONSHIP
MARRIAGE &
FAMILY
ASSISTIVE
DEVICES
SPECIAL/
TRANSITORY
ECONOMIC
CONTRIBUTION &
SOCIAL PROTECTION
LANGUAGE &
COMMUNICATION
PERSONAL
ASSISTANCE
GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~
POVERTY ALLEVIATIONPOVERTY ALLEVIATION
WHO MATRIX

34. Multi-sectoral Support for CBRMulti-sectoral Support for CBR
 Support from the Social SectorSupport from the Social Sector::
Examples: dExamples: disability pensions, technicalisability pensions, technical
aids and adaptations, vocational trainingaids and adaptations, vocational training
and employment, and co-ordination ofand employment, and co-ordination of
referrals for individuals who requirereferrals for individuals who require
services from other sectorsservices from other sectors

35. Multi-sectoral Support for CBRMulti-sectoral Support for CBR
 Support from NGOsSupport from NGOs andand
the local communitythe local community::
 Most communities have a variety ofMost communities have a variety of
non-governmental organizationsnon-governmental organizations
(NGOs) and groups that can(NGOs) and groups that can
contribute to a CBRcontribute to a CBR programme.programme.

36. Multi-sectoral Support for CBRMulti-sectoral Support for CBR
 Support from theSupport from the HealthHealth SectorSector::
The Declaration of Alma Ata (1978)The Declaration of Alma Ata (1978)
states that Primary Health Care (PHC) isstates that Primary Health Care (PHC) is
the key to attaining health for all. It alsothe key to attaining health for all. It also
states that the PHC needs to address thestates that the PHC needs to address the
main health problems in the community,main health problems in the community,
providing promotive, preventive, curativeproviding promotive, preventive, curative
and rehabilitative services.and rehabilitative services.

37. Multi-sectoral Support for CBRMulti-sectoral Support for CBR
 Support from theSupport from the HealthHealth SectorSector::
PHC can play a major role in this contextPHC can play a major role in this context
both as a provider and supporter:both as a provider and supporter:
 Early identification of impairments andEarly identification of impairments and
providing basic interventions.providing basic interventions.
 Referrals to specialized services such asReferrals to specialized services such as
physical, occupational and speechphysical, occupational and speech
therapies; prosthetics andtherapies; prosthetics and orthotics; andorthotics; and
corrective surgeries.corrective surgeries.

38. Multi-sectoral Support for CBRMulti-sectoral Support for CBR
 Support from theSupport from the EducationalEducational SectorSector::
 Adapting the content of the curriculumAdapting the content of the curriculum
and methods of teaching.and methods of teaching.
 Ensuring that classrooms, facilities andEnsuring that classrooms, facilities and
educational materialseducational materials are accessible.are accessible.
 Children with multiple or severeChildren with multiple or severe
disabilitiesdisabilities may access education throughmay access education through
the use of innovative methods best suitedthe use of innovative methods best suited
to their context.to their context.

39. Multi-sectoral Support for CBRMulti-sectoral Support for CBR
Support fromSupport from the Employmentthe Employment
and Labourand Labour SectorSector::
 Collaboration with the employment andCollaboration with the employment and
labour sectors. Productive and decentlabour sectors. Productive and decent
work in a conducive environmentwork in a conducive environment
 Equal employmentEqual employment opportunities throughopportunities through
national policies and legislation;national policies and legislation;

40. Multi-sectoral Support for CBRMulti-sectoral Support for CBR
 Support from the MediaSupport from the Media ::
 All CBR stakeholders should workAll CBR stakeholders should work
closely with theclosely with the media to identifymedia to identify
priorities and to provide relevantpriorities and to provide relevant
information.information.

41. MOVING TOWARDSMOVING TOWARDS
AN EFFECTIVE CBR PROGRAMMEAN EFFECTIVE CBR PROGRAMME
 The following aspects of CBR need to be
strengthened to make programmes more effective:
1. Community Involvement and Ownership
2. Multi-sectoral collaboration in CBR programmes
3. Involvement of DPOs in CBR programmes
4. Scaling up CBR programmes
5. CBR programmes to be used as an effective tool for
poverty reduction
6. Evidenced based practice

42. Who Initiates CBR ?Who Initiates CBR ?
 Community action for CBR is often initiatedCommunity action for CBR is often initiated
by aby a stimulus from outside the communitystimulus from outside the community,,
most likely ministries or NGOs.most likely ministries or NGOs.
 It is theIt is the communitycommunity which decides whetherwhich decides whether
CBR will become part of its ongoingCBR will become part of its ongoing
community development activities.community development activities.

43. COMPONENTS NEEDEDCOMPONENTS NEEDED
TO BEGIN A PROGRAMME FORTO BEGIN A PROGRAMME FOR
THE REHABILITATION OF PWDsTHE REHABILITATION OF PWDs
Look out for….
1. An action area where the need is apparent.
2. A community which is receptive.
3. A resourceful and creative outside agency.
4. Persons with Disabilities who need the services of
external agency , community
for mainstreaming themselves, to set themselves up as
contributors
and not just recipients of service.

44. Steps of CBRSteps of CBR
1.1. Identification of person requiringIdentification of person requiring
rehabilitation services.rehabilitation services.
2.2. Assessment of disabilities and variousAssessment of disabilities and various
needs for rehabilitation of identifiedneeds for rehabilitation of identified
person.person.
3.3. Provide the basic services through PHC,Provide the basic services through PHC,
such as drugs, dressing, materials,such as drugs, dressing, materials,
protective foot wear, counseling andprotective foot wear, counseling and
training in self care.training in self care.

45. 4.4. Introduce / escort the person to villageIntroduce / escort the person to village
health committee along with his/herhealth committee along with his/her
problems.problems.
5.5. Refer to secondary/ tertiary care centersRefer to secondary/ tertiary care centers
6.6. Facilitating the accessibility to socio-Facilitating the accessibility to socio-
economic rehabilitation services.economic rehabilitation services.
7.7. Review meetings by all stake holders, toReview meetings by all stake holders, to
discuss progress.discuss progress.
8.8. Coordination with social welfareCoordination with social welfare
department and working jointly.department and working jointly.

46. Challenges of CBRChallenges of CBR
 Lack of understanding of concept.
 Rapid turn over of civil servants, Finance
/ Prioritization.
 Acceptance of CBR as a valid
intervention.
 Poor Management / planning of CBR

47.  Inter Ministerial Rivalry - Lack ofInter Ministerial Rivalry - Lack of
communicationcommunication
 Evidence based facts not made availableEvidence based facts not made available
 Lack of co-ordination between theLack of co-ordination between the
Government and NGO’sGovernment and NGO’s
 Social welfare department often has aSocial welfare department often has a
weak structure at community level.weak structure at community level.

48. We look forward to a tomorrowWe look forward to a tomorrow
that includes PWDs in the mainstream as equal partners
that does not side stream PWDs